This is a bit of a change in subject matter for this blog, but I have been watching and reading with horror the furore about junior doctors' pay and felt compelled to put my tuppenceworth in. I've actually delayed writing anything for a few days because otherwise there would have been too much swearing involved and my grandma and grandad would be appalled. A few days later I am slightly calmer but not much.
I love the NHS. It has: diagnosed my profound deafness as a baby, given me hearing aids and speech therapy; diagnosed my coeliac disease and provided me with gluten-free food (before gluten-free and paleo were fashionable and when all was available was foot-breaking bricks of bread); diagnosed my Hodgkin's lymphoma and saved my life with chemotherapy and radiotherapy; and with my cochlear implant it has given me a whole new world of sound that I could only imagine before. It has also cared for some of my nearest and dearest in their life-threatening illnesses and at the end of their lives. I'm truly, heart-swellingly proud to work for such an organisation and give back a little bit of what it has given me.
I am however dismayed and demoralised at the recent developments. I should start by explaining how our pay works for non-doctors: we get a basic salary – starting at around £22,000 for an F1 – but are compensated for the many antisocial hours we work with our “banded pay”. This is graded according to the number of antisocial hours (outside of 7am to 7pm, Monday to Friday i.e. evenings, weekends, nights). 1A is the highest band and pays 40% - 50%. So working weekends and nights is slightly less crap because at least you feel you are being fairly remunerated. GP trainees also get a training supplement (45% of basic salary) – this is based on the average supplement that is received across all hospital specialties, so that there is not a financial disincentive for trainees taking up general practice rather than a hospital specialty.
I love the NHS. It has: diagnosed my profound deafness as a baby, given me hearing aids and speech therapy; diagnosed my coeliac disease and provided me with gluten-free food (before gluten-free and paleo were fashionable and when all was available was foot-breaking bricks of bread); diagnosed my Hodgkin's lymphoma and saved my life with chemotherapy and radiotherapy; and with my cochlear implant it has given me a whole new world of sound that I could only imagine before. It has also cared for some of my nearest and dearest in their life-threatening illnesses and at the end of their lives. I'm truly, heart-swellingly proud to work for such an organisation and give back a little bit of what it has given me.
I am however dismayed and demoralised at the recent developments. I should start by explaining how our pay works for non-doctors: we get a basic salary – starting at around £22,000 for an F1 – but are compensated for the many antisocial hours we work with our “banded pay”. This is graded according to the number of antisocial hours (outside of 7am to 7pm, Monday to Friday i.e. evenings, weekends, nights). 1A is the highest band and pays 40% - 50%. So working weekends and nights is slightly less crap because at least you feel you are being fairly remunerated. GP trainees also get a training supplement (45% of basic salary) – this is based on the average supplement that is received across all hospital specialties, so that there is not a financial disincentive for trainees taking up general practice rather than a hospital specialty.
I also have a £45k student loan from my 5 year degree, and also have to pay GMC registration fees (£300 a year), BMA fees (£222), exam fees and course fees. Oh and medical indemnity – as GP trainees our indemnity fees are £1,200 a year as well. We can claim these back in part when training, but not after we become GPs.
I qualified in June 2012, aged 24. Over the last 3 years of working as a doctor, I have missed Christmases, New Years, birthday parties, weddings. This Christmas I will be spending Christmas Day and Boxing Day nights helping to deliver babies and seeing urgent gynaecology patients. I have been verbally abused by drunks in A&E, and scratched, kicked, and bitten by confused dementia patients. I have been covered in blood, amniotic fluid, faeces, urine, vomit (fortunately not all on the same day). I have seen people die in front of me – literally seen the life leave their eyes. I have assisted emergency caesarean sections and helped bring new babies into the world. I have run to many crash calls and been part of the team trying to bring someone back to life. I have consoled grieving relatives; I have held dying people's hands and stroked their hair. I have worked for 12 hours straight only managing to pee once and gulp water whenever possible to prevent my own acute kidney injury.
Please do not think I am either whinging for sympathy or being arrogant - I am not complaining about any of the above. I went into medicine knowing it would be hard and a long slog, and I feel I am fairly remunerated for my work. I love my job and I feel very lucky to have a career that has such a positive influence on so many people's lives.
HOWEVER. On the background of public sector pay freezes for the last several years, the Department of Health is announcing that they want to cut junior doctors' pay even further. This along with an 11% pay rise for MPs!!! An “independent review body” - the DDRB – I doubt any of them have ever worked a night shift in their lives – have suggested removing our out of hours supplement, among other changes which you can read about here.
The proposals – which are shrouded in mystery, apparently because they would “bias public opinion” if they were revealed in their entirety – hmmm I wonder why?! - would increase our basic salary (splendid, more tax to pay and more NI/pension contributions), and would CUT our out of hours pay by stretching the “normal hours” to 7am to 10pm, Monday to SATURDAY. So I would be paid the same for going to work all day Saturday as going to work all day Monday. The proposed changes also remove any penalties that trusts incur for overworking their doctors, so there will be no incentive for them not to put us on completely insane rotas. Specialties that do lots of out of hours work (e.g. A&E, anaesthetics) will be hit the hardest. They also want to remove the GP trainees' supplement, resulting in a 45% pay cut. GP and A&E are some of the hardest specialities to recruit to and this is completely counter-intuitive.
The BMA (the doctors' trade union) walked away from talks because of unreasonable demands and refused to go back because a condition of returning to negotiations was accepting the DDRB recommendations without question. The DoH have said they will unilaterally impose these pay reforms on us, which rather begs the question of why they bothered trying to negotiate in the first place...
They are also unveiling new physician assistant jobs at £50k a year – more than double an FY1's salary. A physician assistant has 2 years' training, and works alongside doctors doing things like taking bloods, cannulas, histories, but can pass any decision-making onto a doctor. A bit like a paralegal getting paid more than the lawyer. This strikes me as similar to going out and buying lots of shiny new buckets to distract from the fact that the ship is sinking. How is this short-sighted and ill-thought-out idea to help with the NHS recruitment crisis?!
I will try not to be too political. However I am very cynical about the motive behind all this – given that the Secretary of State co-authored a book on how to dismantle the NHS , has no medical experience, and his sole qualification appears to be a degree in PPE from Oxford. And when there were 220,000 signatures on a petition to debate a vote of no confidence in Jeremy Hunt, but all that was achieved was this debacle, I think I can be forgiven for seriously losing my faith in this government (not that I had much anyway).
I could have a much better life in New Zealand or Australia or Canada but my family is here. I can't really imagine being that far away from them especially while trying to bring up my own family. Having said that, I have still applied for my “certificate of good standing” (a document you get from the GMC verifying your registration with them) so I can escape if necessary.
I've said it before - it is not about the money – it's about how valued we feel as professionals. If it was about the money I would either a) not have gone into medicine or b) have gone to the Antipodes already. Or I would sit back and watch the NHS being dismantled while I locumed and made a fortune. If our healthcare system gets privatised and becomes like the American system – doctors won't lose out. In a country where there is already a shortage of doctors, it will be an employee's market. We are not fighting this because we are greedy money-grabbing bastards – we are fighting this because we believe in everyone's right to have free healthcare at the point of need.
We are fighting on our patients' behalf, while the mainstream, right-wing media largely fails to report our struggles. Please support us – write to your MP. Let them know you support us. We don't like striking because we worry about our patients, so the government think they have us over a barrel. However I would support a strike, because I genuinely believe our patients will be at greater risk if these contract reforms go through. Do you really want your doctor to be seeing you at the end of a 15 day stretch? Please listen to your doctors when we tell you this is not safe, that we are stretched to breaking point already, and that we are in danger of losing a precious national institution.
